Healthcare Provider Details

I. General information

NPI: 1932973435
Provider Name (Legal Business Name): SABA FESEHA GEBREABE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 GARRISONVILLE RD
STAFFORD VA
22556-3904
US

IV. Provider business mailing address

13037 TAXI DR
WOODBRIDGE VA
22193-6120
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024188162
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: